First of all, I want to congratulate you for your hard work and perseverance in finishing your training to become Board Eligible Psychiatrists since first matriculating into medical school some 8 or more years ago. This is a wonderful accomplishment, I hope I am not the first nor near the last in acknowledging this to you all at this time.

That said, I also want to perhaps be the first to tell you, from a psychiatrist who has been practicing now 20 years, you need to be prepared that whatever you have learned these past 2 or so years since working in outpatient and specialty electives to get you prepared for what you hope to be doing for the next few years at least, your postgraduate experiences will not be as likely what you anticipate.

First off, if you have any interest in independence and autonomy to practice in a manner that serves both your patients and yourself in as productive and efficacious as possible, forget it! You will be micromanaged, second guessed, harassed, ignored, belittled, and just plain dictated to in order to achieve others’ goals that may have clinical care somewhat concerned, but it is serendipitous at best until proven otherwise. No, if your mentors, supervisors, program directors, and other directorial inputs have been at all honest and direct with you since starting residency, and you care about providing the best patient care possible, you would have left the program by now if those truths and revelations were made clear. Simply because you are now agreeing to basically just prescribe medication and give limited, selective diagnoses that serve insurer and/or bureaucratic agendas first and foremost.

Furthermore, if you have any interest in providing patients a level of care that maximizes outcomes in restoring healthy and functioning abilities, be ready that is dumbed down to figuring out what is the best management of biochemical imbalances that define the patient’s disorder. Note it is not even called an illness or disease anymore. No, your interest will be narrowly directed to prescribing more likely multiple medications from moment one of meeting the patient, and patients will be more likely to be expecting you to provide the best medicines to make the symptoms be removed within a week at best. And, therapy is not an option, probably something that you have been told already, much less not provided the best training to master a few psychotherapeutic interventions as eclectic care is no longer a concern, because it has been drummed into your processes that there is no reasonable reimbursement opportunity to provide appropriate psychotherapy from a psychiatrist’s perspective.

Finally, and this one is solely my opinion but one realized by the history of what politicians and bureaucracy’s history in this country of regulating care has resulted to now, because of the Patient Protection and Affordability Care Act (i.e. PPACA or more well known as Obamacare), you most likely will be working in one of the following few treatment positions by 2016: State or federal or privately run community mental health clinic outpatient work; inpatient acute care via conglomerate hospital organizations or chronic state run facilities; addiction program psychiatric consultant work; VA programs; correctional facility mental health management programs; or, micromanaged “private practice” run most likely by non psychiatrists that have to answer to insurer panels that will only authorize services you agree to by contract that have no real negotiation in rates of reimbursement or practice interventions.

I am sorry to forward this correspondence at a time you are preparing to begin your paths to allegedly less supervised and more independent opportunities to provide care and access collegial interactions to allow you to be the best psychiatric provider possible and grow as a physician. But, I think to not note these above impressions and experiences by a predecessor, who was as eager and invested to “blaze a trail of good care and autonomy” as you all hopefully are now, but from what I see these 20 years later what the system really allows and expects of graduates, to not do so would be negligent and disrespectful of your position now.

I hope to finish on a positive and motivating note though, and that is simply this: if you compromise and minimize what you know are the standards of care, if you allow people who are not peer equivalents and have no accountability for the potential less favorable outcomes to care interventions should you follow those persons’ leads, and if you are not completely committed to what you spoke at your Medical School graduations in reciting the Hippocratic Oath, then you will either fail in your goals or sell your professionalism out for less admirable needs, SO DON’T!

Do what is right, what is the standard of care, what is in the patient’s best interest first, what your respected colleagues and mentors would expect and duplicate in their practice styles, and what allows you to lay your heads down each and every night and rest as peacefully and soundly as possible.

You are an important part of what psychiatry needs to be redoing right and responsibly to the communities we serve, and really protect in these days of uninvestment in care by non clinical entities trying to control and dictate health care, more often solely for the sake of profit. And I think many of you can make a difference for the right reasons. I just hope you had the influences in your trainings these past 4 years to remind you what you need to do.

As I write at this site often, be safe, be well, and for you as graduating residents, be right and firm!

Like this:

Related

Post navigation

18 thoughts on “An open letter to graduating psychiatry residents.”

Thank you for directing me to your site, Dr. Hassman. Narrowly directed interests and high expectations with pharmacotherapy-only interventions is certainly shared by other physicians, especially in primary care. I think all new residency grads could use the warning. The words of encouragement are also appreciated.

Appreciate your time to read here, hope you are working towards options after residency that are fulfulling and worthwhile. Sorry to say, if I could go back to the end of medical school knowing what is the practice as is today, I would not have picked psychiatry, but, not sure what else would have been a realistic alternative for what I inherently wanted as a physician. I like talking to patients, and like practicing a biopsychosocial model to health care.

What is this lame comment pattern by these loyalists to Hickey? I print it solely to reflect how empty and vapid in just the endless shout outs of “psychiatry should not exist” and then lamely defend it as not at all like what the Nazis said about how the Jews should not exist. Or, my favorite from the thread will forever be this textbook example of what extremists and zealots do and then deny and deflect as being wrong:

“Suzanne Beachy (MIA Author)
on June 17, 2014 at 10:29 pm said:
It’s not just you, John Hoggett. I, too, find Joel Hassman’s rant in this comment section to be pretty much incomprehensible. Like you, I get that he’s miffed and defensive. At least he is able to express that much pretty clearly.

I also took a look at his blog, titled “Can’t Medicate Life.” The very first words under the title are these:
“If you want to get better, take a pill”
LOL! Why is he lambasting, blaming, and shaming psychiatric clients who are simply trying to follow that advice?”

Francesca Allen then goes on to appropriately call Ms Beachy on how lame and out of context her comment was, but, those antipsychiatry buffoons don’t disappoint, with this retort later there: “Suzanne Beachy (MIA Author)
on June 18, 2014 at 7:50 am said:
ha ha ha ha WHAT “context”?! How is quoting the first half of Joel’s nonsensical buzz phrase “dishonest?” ”

Oh, and by the way, the definition of buffoon is this:

buf·foon noun \(ˌ)bə-ˈfün\
: a stupid or foolish person who tries to be funny

I don’t get your point, if you are making one here. Did you read the whole post, or just select the one segment that fits your narrative, I sense per the tone of this brief comment you are not very supportive of psychiatry as a whole.

I’m going to have to once again respectfully disagree with your very, very broad strokes of the brush.

Speaking from my perspective of almost 50 years as a support person and health care advocate psychiatry does have a very important place in medicine and health care and to my way of thinking as it is on cusp of understanding some of the physiological basis for mood disorders. This is not to the exclusion of the various disciplines of talk therapies etc. and their value.

I see the beginnings of psychiatry no different than many of the other disciplines of medicine. That is the superstitions and fumblings until more disciplined research and science was applied.

As a health care advocate I have always espoused the least invasive therapies to be considered first and so on down the line.

What you refer to as labeling I prefer as diagnosis. That is a set of symptoms we can observe and listen to when discussing the illness (i.e. MDD) instead of having to repeat the laundry list of our observations each and every time in discussion.

Having tried to overcome Joyce’s illness we went from and utilized individually and/or in combination nutrition, exercise, holistic therapies, and numerous disciplines of talk therapy, medications and so on. As a support person I carefully read all pharmaceutical inserts and literature. There are very few if any drugs and/or chemicals that don’t have “potential” side-effects and worse yet some with potentially very serious side-effects. I’m sure you’re also aware of the dangers of the common aspirin. Then again, even water, taken to excess, can kill. The important point is to be knowledgeable and aware.

Contrary to your thoughts about ECT, at this time, I still feel this therapy has a rightful therapeutic place although the newer neuro-modulation therapy of TMS (Transcranial Magnetic Stimulation) and several other neuro-modulation therapies I personally would consider first if other therapies have proven ineffective and/or refractory and one were at the serious stage of acting upon one’s suicidal ideations.

As for concussions, not necessarily true. Joyce has had numerous CT scans and MRI’s of her brain since having had ECT and the results have shown her brain is normal for a woman of her age. There is no definitive evidence from my readings that ECT causes concussions. ECT may well exhibit symptoms of concussion but physical damage not necessarily true.

As for your dramatization of hospitalizations I’m sorry to state that our experiences would sharply refute any of your thoughts. She was always respectfully, safely and well cared for during each of her numerous past hospitalizations.

As a former Guardian Advocate by appointment in the State Florida I truly believe The Baker Act (up to 72 hours of involuntary observation and evaluation) serves as an important safety net and not for the purposes of dehumanizing or illegally incarcerating anyone but as a means to obtain emergency medical attention.

How does a psychiatrist possibly keep such an oath while practicing what he/she was taught in medical school/residency?

Your “medicine bag” contains:

1) Diagnosis – which is often dehumanizing, marginalizing… often costing a person their standing in the community; often with legal ramifications… taking away the one thing people in distress need the most – hope.

2) Mind-altering drugs – each class is dangerous, causing more harm than good with long-term use.

3) Hospitalizations – incarcerations that involve scaring the ever-lovin’ crap out of someone who is already in severe emotional distress

4) ECT – a brain concussion. Period.

In short, the problem is what’s in the medicine bag.

The only way to “do no harm” is to put away the medicine bag, and replace it with non-medical approaches – listening; creating dialogue; helping build relationships. Although this can be done by non-medical folks – counselors, therapists, clergy.

Wow, what is the size of your brush you paint psychiatry as all evil, 10X10, as in yards?

No, you just use a firehose of black paint. Note I did post almost all your comments except the correction one to show readers what I sense is a fair illustration of the antipsychiatry crowd who is not interested in negotiation nor dialogue, just the jihadist approach of “it is our way or no way”.

By the way, much to your denial of this, treatment is a choice, people can choose to not come back if not satisfied with the interventions offered, so this “muzzle to the temple” attitude the antipsychiatry crowd erroneously claims is just, well, lame. And why I do go after this crowd at my site, the characterological flavor of most commenters is just textbook at times.

Hey, just my opinion, but, this lobby doesn’t want opinions at the end of the day.

Thanks for your offering what is accepted as just an opinion, not gospel.